Hi, I'm Sarah Lavonne and I'm so glad you're here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life both in and outside of work. But don't expect perfection over here. We're just here to have some conversations about anything birth, work, and life. Trying to add some happy to your hour as we all grow together. Bye nurses for nurses. This is happy hour with Bundleber Nurses. We are back with Rose Horton again. If you listen to last season, we had a really amazing conversation about not on my watch and morbidity mortality and then there was this little teaser where she dropped this story and I was like wait ah we have to talk about that and there was no time for it. And so we, as we said in the last episode, we are back and we are going to pick up that conversation where we left off to the point where I have actually the transcript here. And so I'm going to read a portion of where we left off and then we'll keep the conversation going in the direction that it was. So while it may have been months later, here we are. And I'm so excited to keep the conversation going. So, we were talking about soft skills and changing outcomes, particular particularly morbidity and mortality. And I said, this is exactly why we're talking about it. It's the soft skills. It's the internal work that we do as nurses that equip us to be able to show up at the bedside with your hands open ready to listen. And then sort of this idea of I'm present. I'm watching. I'm seeing those subtle changes in the patient. I'm noticing the little inflection in their voice that might change and I'm going to pursue curiosity in that and I'm also not judging you for wanting certain things and taking on too much etc. And then I said, "This is what not on my watch is about, right? It's about it's about reducing morbidity and mortality in healthcare and really the culture of O of OB. We need all of that in the culture of OB." And then you said, "Exactly. I remember when we put several things in place at my last organization here in Atlanta, part of the Emory system. We were intentional in putting a lot of things in place because we wanted to have more equitable outcomes because our outcomes were better for some people but not for others. We wanted to change that. I remember getting our press gainy patient satisfaction scores, reading them and crying my eyes out because it was women saying all the things you just said. These are black women. 67% of our patients at my former organization look like me. I felt seen. I felt heard. I felt safe in a time when black women are not seen, not heard, don't feel safe, scared for their lives. Scared to let their bodies do because, you know, cortisol is coursing through our bodies. Adrenaline is coursing because we're fearful. We're afraid of dying in childbirth. Our bodies can't do what it should do. Because of that, we were able to create a culture that allowed women to just be in their own experience and trust us, knowing that we got them. And I said, 'W wait, what culture is that? How did you do it? I said, 'I know we're going on another tangent, but I think it's so important. And then you said, 'Well, we don't have enough time. And I said, you're right. Oh my gosh, you're going to leave me hanging. And so you said, that's definitely another conversation I'd be happy to have because it's the reason I'm self-employed and work and work so beautifully to get those results. We can be a part of a bigger change. I can make myself available. I can partner with other nurse leaders and work on this equity journey. So talk to me about that press gainy moment where you're reading the HCAP scores and you're going they felt seen, they felt heard, they felt safe. Yeah. So I think it makes perfect sense to begin at the end because that was definitely at the end. Um probably around the end of 2023 last Yeah. the fourth quarter of 2023, first quarter of 2024. Um, seeing age cap scores, something that's really important to us because we want to know the patients experience in their own words and looking at their comments, you know, not just the scores, but their comments that they typed in. And to see words like I felt seen, I felt heard, I felt safe, um totally reduced me to tears because that was our goal and our objective even though we didn't define it that way. Um we're defining it around how do we create equitable outcomes. Um, so the fact that we reached a secret goal definitely in my heart that I hadn't articulated was super powerful and you know it leads back to the um origin story, right? Um, and the origin story was what started in 2017. in 2017 um doing some research for a presentation. I was asked to do a presentation. Um at the time I was interim interim at um my hospital in Atlanta and had not been working with the OB population for about three years. I was doing some other fun exciting things. And so when I was given the opportunity to do a presentation in front of the leaders, um the plan was that there would be about 250 leaders there. It was called the leadership development institute which we called um LEI. They said, "Rose, we'd love to hear your why." and they host a leader every quarter at this retreat um to see why did you choose healthcare or why did you choose you know to be a nurse to be a physician whatever you chose and I was honored to be asked that question and I said what if I'm going to be in front of leaders let me let me you know get my act together and have some really good data to show why the women and infant service fund is important because throughout my leadership I would hear things like um women infant services is a lost leader and that we're not bringing any revenue to the organization. We're not the priority. No, I Yeah. Yeah. That's for another day as well. So I said I said, "Okay, I'm going to be prepared." So I'm in my hotel room. I'm googling. I'm like, "What's up? What's up in OB?" And I read a story about Kira Johnson dying in childbirth. I'm crying. I'm like, "Oh my gosh." Okay. And I keep looking and, you know, the algorithms get you. And then I read a story about Lauren Bloomstein, a NICU nurse in New Jersey who lost her life um preventably. And then I read about Shalon Irving, um, an epidemiologist, many degrees, smart, living in Atlanta, um, who lost her life prevent preventively as well. And I was like, what the heck? And then it led me to ProPublica, their work on the lost mothers. I'm like, oh my gosh, what has happened in the past three years? It was a horrifying moment. And I'm like, okay, get it together, Horton. put it together. And I I remember thinking, what can I do? What can I do to be part of this solution? And that was the birth of not on my watch. I was like, okay, you know what? Within my locus of influence, this is what's not going to happen. So, it was the birth of not on my watch. And I remember as I was creating my slides, and I just put it there, hashtag not on my watch. I put it in purple because this is my favorite color. And when I did my presentation, I remember saying to the team, all 250 of them, that this hashtag is going to go viral, even if it means it's going to go viral within our healthcare organization. And people like laughed and you know, I laughed. It was it was all good. Um, so that was the origin story. And the interesting thing I always uh tell my family that was my TED talk because I had like 14 minutes, you know, and that's not enough for nothing. Oh my god, it's nothing. It's like spitting in the wind. I'm like 14 minutes. Okay, what can I do? I'm like, think of this as a TED talk. And I remember in vanity and I can share it with your many thousands of people who listen. Um, but I remember sharing with my daughter. I said, "Okay, I have like 13 minutes when it all boils down." I said, "I want to make them laugh. I want to make them cry. I want a standing ovation." And my daughter was like, "Here for it, mommy. You can do it. You've you've got it." Um, and all of those objectives were met. Laughing up. Um, crying. Even the person at the end who was wrapping things up, repeating some of my words, just crying. A line of people wanting to talk to me afterwards. Um, and I'm like, "Okay, all right. So, this is fertile ground to talk about not on my watch." And that started our journey. I didn't know it was going to be a journey, a journey towards equity, but that really informed everything we did for the next five years. And the ending was black women saying, "I feel seen. I feel heard." And it was amazing. It was amazing. So it all and then I took it to my leaders. Many of them were there um at the leadership development uh institute and I had talked to them before. I said it, "Hey, I'm like, I have a hashtag y'all. We're going to do this thing." They're like, "Yes, yes, this sounds great. Let's do it." Um, but that led us to um creating some education. The first education we created in 2018 um was called respectful, equitable care. It's like how do we ensure that we treat everyone with dignity and respect? Everyone. Um, so that was the first um three-hour mandatory for everybody in the service line. Not just labor and delivery, not just postpartum, it was everyone in the Q and everyone. So that was the start. And every year we had three and a half hour mandatory. If you're a tech, if you're a unit secretary, if you're a nurse, as long as you report to this service line in Teros Horton, you are going to be part of this education. So there was a lot of intentionality around the topics. We wo in a lot of data because we wanted people to see this is where we are and we share data on a weekly basis. Some may say that's too much. I don't. On a weekly basis, we share data because we're used to getting things quarterly, right? And then reacting to something that happened maybe two quarters ago. We were like, "Nope, we're measuring. We're going to share it with you." And um what were you measuring and sharing? Yeah. Um definitely our age cap scores, but after we did that respectful equitable care class, we decided to look at one of our metrics in the women and infant service line. Um you know, one of our our core measures for joint commission and we said, "Well, let's look at breastfeeding. That should be pretty innocuous and easy. Let's look at breastfeeding. Let's look. And we pulled up our breastfeeding data and it was great. You know, we were like really sucky. And then we decided to become um a birthing friendly breastfeeding a baby friendly baby friendly. There's the birthing friendly from CMS. Uh we wanted to be um a baby friendly organization. So you can see that we increased when we did that. There was education and then the second time that we had to reup we kept going up and it looked great. It's like okay this is good. Um and then as we were learning about equity we like okay let's look at this not in the aggregate but let's look at the stratified data. Let's look at the top five um races that we report to. So we looked at our white patients our black patients Latino patients um Asian patients and then the fifth was other. The majority of our patients, 65 to 67% were black patients. Overall, great, trending, great. Yay, we're better than the national average. This is fantastic. And then when we stratified that, we were terrible for some. 80% was the breastfeeding rate for our white patients, 18% of our population, 80%. For our black patients, it was anywhere from the mid4s to the mid-50s. It's like why why? So every year I have a mandatory meeting usually bianually because I want to see my people and tell them about our initiatives and have facet time and give them some food and you know kabits and catch up with with the people. So we had our meeting and I shared the data. I'm like look at this. What do you guys think? And people looked genuinely horrified. And then they did something that's known as victim blaming. They blamed the patient. They're like, "Well, black people don't want to breastfeed. Um, it's the physicians. They're not teaching about breastfeeding in the prenatal space. Um, we really have to address the black birthing person's mother as that maternal mother. She's the one." It was so many things. I'm like, "Really? Wow, that's really interesting." Um, I didn't believe in my heart that was it, but I'm like, "Okay, that's really interesting. So our team went back together and our data nerd u made a brilliant recommendation. She said because we were looking at all patients right all patients who came in what that was our denominator and then the patients who were still breastfeeding on discharge was the numerator. She said let's change it up. Let's make the denominator all of the patients who on admission to labor and delivery and or triage say my feeding intention is to breastfeed. I'm like perfect because they're like it's education. They don't know. They don't want to do it all. Like okay. So we changed the data and this this takes time, right? So six months later we had another mandatory meeting. I'm like y'all thank you so much for your feedback from the last meeting. Um, so we change the denominator and this is what we've been measuring. So my expectation is if a patient shows up to labor and delivery and she says my feeding intention is to breastfeed that they should be breastfeeding on discharge. Like do you guys agree that makes sense? Yeah. Yeah. Yeah. Totally. We totally agree. Like let me show you what the data says. Um, and guess what Sarah? It was no better. It was still disproportionately there was it was so disperate. And I said, "So, we have some Latino women, some black women who are coming in saying that they want to breastfeed and they leave not breastfeeding. So, it's not education. It's not the physician. It's not their mama. What do you guys think?" It was a really hard awkward conversation. And I usually have six of those meetings because I want to meet the week be with the weekend people, the night shift, all the shift, right? Every meeting was equally painful. Like, what do you think? What what's the problem? The first two meetings I, you know, I finally had to say, is it possible that we're the problem? We're like the only variable in this equation. Could it be us?

There was some offense taken to that and I think the word got around and some people were genuinely like yikes. Yeah, that's quite possible that it could be us. So our next series of classes we started talking about um shared decision making that how do we leverage shared decision making? So, that's information that we were sharing on a weekly basis. We're sharing um the percentage of patients who came in and said that they want to breastfeed, the percent that are leaving not breastfeeding, and we broke it up by race. We did it by the week so that people can go back and say, "Well, I took care of that patient." Because that's the conversations we were having as leaders. Um, hey, tell me, do you remember this patient? Tell me what happened with this patient. and and as we moved along, it was more less reactive and more proactive. And we shared everything with the team. We're going to be rounding intentionally and asking these questions. So when they see me on their unit, sometimes they would try to hide, but I'm faster than they are. I would say, "Hey, tell me about your patients." So it was more like, "Who are you taking care of today? Do you know how many of your patients um are planning on breastfeeding exclusively? Can you tell me what your plans are to help them to be successful to meet their goals? So, it became more of a proactive conversation and it got to the point that they're like, "Oh, here's Rose. Let me tell you about okay, here are my couples. This is what I'm doing." Um, and also during that time we really wanted to reward those who were always consistently stellar. So we had a breastfeeding champion award that people like really were vying for and working really hard to get that award because we wanted everybody to be that person. um in the middle of this probably over like a nine-month period, we hired a new um tech for the postpartum unit and she made an observation and I'm so glad we're working on the culture that she felt comfortable going to her leader and she said, "I need to share with you something that I'm noticing and you know, I'm not sure what to make of it." And her leader said, "Yeah, I am. Tell me tell me what you're seeing." She said, "Now I'm taking care of lots of patients and many of them we know that they want to breastfeed exclusively. Given that they want to breastfeed exclusively, there are issues, right? And sometimes they need supplementation. And what she noticed with the supplementation is that some patients would be supplemented with formula and some patients would be supplemented with donor milk." And she said, you know, unsolicited, unprompted. She's like, I was I paying attention to the trend. And she said, anecdotally, what I see is that the black patients are getting supplementation with formula and the white patients are getting supplemented with donor milk. And we were like, yikes. Here's a process that we had not standardized, right? We didn't have a standard process for supplementation for patients who were breastfeeding and it was a huge opportunity. So we quickly said, "Okay, here's a process. Here's a checklist. This is what you do." If the patient has said that her intent is to breastfeed exclusively. She supplements with donor milk, not with formula. Um, and you know, it happened organically. We were so thankful for it. so thankful that we can, you know, nip it and add that level of standardization and things continue to improve. I remember rounding um and this was quarter 4 of 2023, rounding on the postpartum unit and chatting with a family and saying, "How's everything? How are things going?" She's like, "Oh my gosh, this has been so great. Um I'm so thankful we came here. You know, we've heard about this hospital and we wanted to be here. I'm so thankful we came here. She said, "I want to tell you something." She said, "Please do not get our lactation consultants in trouble." She said, I remember she said, "I'm trusting you, Rose Horton." I'm like, "I got you. I got you. Whatever you told me stays right here." She said, "She is the most phenomenal lactation consultant that there is." And she's been so wonderful. And um she's been such a huge help. She said, "I didn't expect to have a a black lactation consultant." And she said, "She's been great." She's like, "But what I want you to know is that she is giving me donor milk to take home with me." And she said when she gave it to me that that's not the policy, however, that we're committed to her success. And to that end, she's going to give me some to take home while my um breast milk comes in and if I have any issues. And she also said that I can call her if anything goes ary. She's like, "She's the best." I'm like, "Oh my gosh, she is the best." And I knew who it was before she even told me the name. Um, but that's how committed our team was to ensuring that everybody had access to what they needed to be successful in removing barriers. And I don't think that would have happened if we hadn't started by saying, "Look at our data. we're horrified. Let's have some education. Let's let's um weave in some accountability. Let's do the right thing for the patient. That people were all in to ensure that our patients had success. So, it was a beautiful thing. It was a beautiful thing. And what an incredible story. I'm as I'm listening to you, I'm like, "Okay, so I'm thinking about the system." And when you saw the discrepancy between race in HCAP scores, you made the goal and the project, the focus so much smaller, quote unquote, that was like much more tangible, much more realistic, smart, our smart goals. and you know and then you focus in on that one specific thing to help reveal the issue. And I think, you know, I am like a big thinker. I am like a let's go in and shake it up. Let's do the whole thing. And I'm here like as I've come into this conversation, I'm like, okay, what's the solution to systemic racism in healthcare, particularly OB? Like, you know, I want to answer that question. I want I want answers. I want you to tell me what to do. I want you to tell us what to do and you know and I'm ready to go and I'm amped up and all that. And what I'm slowing my role on right now is like, okay, what a really helpful tangible way to reveal the issue with data because especially as healthcare people, but also when you're dealing with something like this that is often not overt and there is a lot of internal emotions that get stirred up and You're asking people to look at themselves internally, not just show up and do a job. And then you're dealing with, you peel back even more the like history, the way we're socialized, how we grew up, our family of family and culture of origin stuff. Like I I mean we're this is complicated. This is not like I am well aware that I'm not going to be able to sit on an hourong podcast and you be like here's the fix to systemic racism like you know and if only. Mhm. And yet what I'm seeing here is that when we look at our your sphere of influence or what we can control to make it more tangible, show up with the data and give some very easy stepbystep processes to respond to the disparity. Mhm. Actually, I'm like, if I was in that scenario, it's like a slow roll out in like the most loving way to showcase the problem and then showcase the solution, which is standardization in this case, right, of like you have to have a standardization and then you follow the steps. And if you're outside the steps, there's also room for accountability there if people don't follow now the policy, right? And so you take breastfeeding as one and then you could take something else as another and something else as another and you slowly unravel and reveal the problem and provide a solution. That's what I'm hearing from all of this. No, that's exactly that's exactly right. And I'm going to take you back just one step that I failed to mention. So um you know the AIM the Ames bundles, right? I think it was in 18 there was a bundle around equity and so right around not on my watch time and that's when we first said hey because and that bundle is not readily available and if you Google really hard you may be able to find it but that was when we first heard um the recommendation you know they had the the four Rs and then they had a fifth R over time for respect um But one of the um recommendation was to create a disparity dashboard. Had never heard that term before. Um and my same data nerd, she's like, "We need to create a disparity dashboard." And she's like, "This is a dashboard that we can look at some of our metrics um and to see them by race." So we put our top train commission. So it was breastfeeding, it was um C-sections, and it was induction. So we looked at all three of those. That's where we started and there were disperate outcomes in all of them and then we asked a decision what is within our locus of control you know inductions not so much c-sections some but not so much so breastfeeding we were like let's start with breastfeeding but know that we went through the whole thing it's like let's start with breastfeeding because I felt like we could do it with breastfeeding and I thought if we have like a a quick win. Nothing's quick, but a quick win that it make it easier for the harder ones because we did have the C-section conversation and we definitely had the induction conversation. That was that was a sticky wicket. Um, but we looked at all of them and then we landed on on that. But yes, I think it comes to, you know, we can't boil the ocean, right? So, what one thing can we do that's going to galvanize us and help us to recognize and embrace the influence and the control that we have so that we're like, "Oh, well, if we can do this for breastfeeding, surely we can start looking at the C-section process and surely." Um, so it worked for that. Thank you for saying that it's complex because it is very complex and it's multiffactorial. I can say that easily on one end and then on another end I can say it's super easy. So simple. So simple. Yep. So simple. Um but the simple one is is not the desired one, right? because it does take a lot of um introspective self-reflection about how do I show up, you know, how do how do I show up? What are my stereotypical thinkings? What's my bias? Um so that really led it it's so interesting as I look back at the five years. Um we had some attrition. We had some attrition especially in our smallest department which was lactation um because it was such a focus about black women actually do want to breastfeed and you know and how says that we're part of the problem. So we had some natural attrition and when that happened we were intentional because that was the one department that was the most um homogeneous. it was, you know, the one that had one primary predominant race and it was black um lactation consultants. And if you do any research, you'll see across the nation that lactation consultants for the most part are are white and um you know of a certain age, a certain tenure. Um so when we had attrition when people for varying reason we had somebody retire um we had someone move to a location closer to them and we had a couple that like you know it's not for me anymore. Um we intentionally recruited and we reached out to community partners and said hey we have we have a lactation consultant um position opening up. do you know anyone who would be interested um so that we could get folks that are in the childbearing age you know minor things um and folks who resemble our community. So, there were so many parts to that. And one last part I want to say as it relates to breastfeeding as we made the decision to open it up and to intentionally reach out to like Black Mama's Matter Alliance. They're here in Atlanta. We reached out to the office of Wick because we knew that somebody in there might be interested. We reached out to a company called the Center for Black Women's Wellness. you know, we reached out to those different organizations to say, "Hey, do you know anyone who might be interested in this position?" Um, then we were thinking about um there's the IBCLC and there's also the CLC, right? The IBCLC, that whole exam is extremely rigorous. You know, I've never taken it, but I've heard that from my amazing LC's who have taken um that exam. So what we discovered when we said let's recruit other people is that our job description for lactation consultants we had two we had the RN and then we had other people because we had um an IBCLC who was um she was a dietician um so we had people with other bachelor's degree that were IBCLC's but what we discovered is that the RN had certain pay scale and Everybody else had a different pay scale. Job expectation was exactly the same. Um, and that was another fourmon fight. So, we wanted equity there. We're like, if they're doing the same job, they should get paid the same. Girl, what? When I tell you that, I thought I was going to lose my job for that one. For real. For real. Um, and yeah, that was the hornets net. And we went all the way up and, you know, when you're in a health care system, you have to have many layers of conversations versus when we were just, you know, community- based organization. We could have gotten to that quicker, but we weren't any longer. We're part of a healthcare system. And it was a conversation that I had to pull my chief nurse in. And it was there were two of us. it was the hill that both of us were going to die on because it's like listen what's not going to happen is we're not going to have people doing the same job and not getting this, you know, the exact same pay. I mean, that's the perfect definition of inequity in pay, right? Um, so we finally got that figured out. And when I tell you the joy and the appreciation, I mean, people had like a 20 30% increase in pay. Wow. When we agreed that there's going to be one salary as long as you have a bachelor's, it doesn't matter what your bachelor's is in. If you've gone through the rigorous process of being an IBCLC, this is what you're going to get paid. So, we felt like that was an exercise in equity as well, that if we're going to invite people in, that it's okay if they're not a nurse, it's okay if they have another degree and we're going to honor them with the same pay. So, and you know, nobody wants your salary to go down. So, the salary didn't go down. Salary went up to reach the RN. Love that. Yeah. So, that was that too. I feel like all of us, if you've been in OB for a while, you've listened to a pod, you've done read a book, you've taken your health streams. At this point, we've been talking about equity forever. Um, and don't get that confused for equality. Equity more like for forever. And so, you know, I'm thinking about who's listening and particularly this audience. I feel like we're all like, uhhuh, yep. The the we're not going to argue that the system is rigged in many ways and that there are inequitable outcomes happening across the board across our country of the US. Now, if for those that listening and you're like, wait there, wait, what do you mean? There's so much data. I can link lists of resources down below. I don't I don't want to spend our time there. But what about the nurse that's listening and saying I've done the work and may let's pretend it's me and you can speak directly to me with how I present and my background and all of that that I I am Caucasian. I am heterosexual. I am 38 years old and a nurse at the bedside. And I'm thinking, well, I treat everyone the same for sure. I just treat them all the same across the board. I'm There's no way that I'm contributing to the problem. What would you want if you could be as blunt and straightforward and not have to like sugarcoat my feelings? I'm here to receive. What would you say to me? I would say there's a problem in you saying that you treat everyone the same because we're not the same. Let's just start there, right? So I think that whole mindset is problematic because we're different. We're so different. And equity means that you will get in relationship with me and say, "Okay, white, cisgender, 38, lovely, she wants to change. Let me let me share a story with you, you know, let me connect with you at the heart level. Let me tell you what has happened." Um, so I that's the first thing that gives me pause. You saying that you you treat everybody the same. We we can't that doesn't work. We're not the same. And understanding that, you know, I love the graphic that we have for equity. You know, the the one box, the two box, the three boxes. I'm sure everybody has seen that nowadays. Um PQI, the Institute for Perinatal Quality Improvement, they have um the pregnant women with the tree, you know, boxes under the tree. I love the graphic because it's who we take care of. Um, so somebody is going to just need one box. Somebody will need to somebody will need three. And in PQI's graphic, um, and there's like three boxes in the equality one where everybody gets one box, there's like three boxes just chilling in the side. It's there, but everybody still gets one and only one person can reach the fruit, right? Um, I do believe in the United States that we have the scarcity mindset. Yes, we really do. We have a scarcity mindset and we live in a country of abundance. Abundance. I cannot tell you how many storage new storage places are popping up. I'm like, what a strange concept that I don't have enough room for my stuff, so I have to pay money to store my stuff every month. Yeah. If that's not if that's not a great definition of abundance, um I don't know what is. Uh and I I will own it. I have too many I have too many shoes. I know that because I have them in a couple of closets. I have too much clothes. I hate throwing away food, which means that I have too much food and I can't eat it all and it spoils. We live in a country of abundance with a scarcity mindset. So the scarcity mindset harms us in that We have a tendency to hoard because we have that what if. Well, what if this happens and we don't have anymore. You know, we can kill ourselves with the what if. Um, not understanding that when you provide equity, when you give the person who needs two two boxes and the person who needs three three boxes, the benefit is not just for them. It's for the whole community. Everybody wins, right? that the rising tide lifts all boats. Everybody wins. I remember in the early days of doing work around disparity and around um equity and people saying, "Well, we can't just do something for black women because we have a scarcity mindset." It's like, don't you know that if it improves anything for black women that white women benefit, Latino women benefit, Asian women benefit, the human race benefits. It's something as simple and as singular as that mindset, scarcity versus abundance, I think could be transformative. Mhm. I can think of a conversation that I recently had with a white friend of mine who was lovingly and very curiously opening up a conversation about equity and disparities and she could not get her head around how she was going to do extra effort for somebody because they're black in this case. What would you say to her as related to the the conversations that we're talking about right now? Yeah. And to be completely honest, um, you know, I would appreciate that level of vulnerability and transparence, transparency and say, "Girl, I don't think this is the job for you." Quite simply, this is not the job for you if you're not willing to put in extra effort for one person. Why Why are you here? Why are you here? I I I can't think of anything. I mean, I don't think that I was not that blunt with her, but that was sort of part of where the conversation went because it's like what is our job as and I want to say nurses, but like human beings, y'all. We are all different and we all have different needs. We all have different past traumas, we have our whole life, everything that we're bringing into the room. And like to me, the definition of individualized care is going to require you to do more for certain people than others. No matter whether that be because of the color of their skin or because of their body habitus or because of a maybe a disability or a you know some sort of of discrepancy in the pro like they've they've done no prenatal care. You are going to have to do a little more. And yet we blame the patient. It's that victim blaming again. And yet it goes all the way back to the beginning of our story of, you know, you come in and you're like, "Okay." And instead of being defensive and instead of like being angry, which I appreciate your demeanor in this whole thing, I I need to work on that cuz I get really feisty about things. But you're like, "Okay, I'm curious, not judgmental, and I'm going to take six months," which bless you, you know? And I'm like, "No, we need to talk about it now. We have to fix it now." Oh, you know, and I get like really feisty about it. And yet, you came back with data to say, "Let me help you see what I see with the numbers." And the numbers are so incredibly clear across the board. Like, I'm tired of talking about them. And yet, we say this in nursing, and to me, this is a human issue. We know it's a human issue but it is it is amplified through our profession because you add female at least female parts giving birth which is a very like womanly thing and then you add so you have that dynamic and then you add the race on top of that and then you add all the other differences we'll say that are there which again brings me back to our the whole thing of like this is simple it's like kindness and individual care and what respect looks like. So, how would you define respectful care? Let me just say one thing again to your friend. Um, and you said this, but I just want to make it even clearer. If she had a patient that had um below the knee amputation that was going to require help to the bathroom versus someone who has two legs, that's additional work. That's the same thing. That's additional work. And you know it's not every patient, right? How many, you know, amputees have you had in labor and delivery? I'm making a bad uh example, but still it's something that you can visualize. Um we need to be willing to go the extra mile because it's a humanistic approach and as well it's a um a nursing approach. So the code of ethics, the NA code of ethics, anybody ever heard me speak, they've probably heard me quote the code of ethics. Um there's 10 of them. There was nine for like 15 years and in 2025 they relooked at it and added a tenth and also relooked at the interpretive statements and added a statement under every code about bias. They were intentional the American nurses association in the interpretive statements to talk about bias. So code number one that the nurse practices with compassion and respect because she sees inherent dignity, unique attributes and worth in every person. That's code number one, compassion and respect for everyone. Everyone has worth. They have unique attributes. They have dignity. Um so I feel like that's our duty. Our duty is to show up with compassion and with respect. How would I define respectful care? I would define respectful care as care that really incorporates compassion. It incorporates centering the voice and the choice of the patient. It incorporates the humanistic philosophy that everyone has value. I I that's what I would that's how I would define it. Um you know, and many times we're like, well, think about how you would care for your sister or your cousin or your we've been saying that for years and it doesn't it doesn't help. we must have a bunch of dysfunctional relationships and we hate our sisters and our mothers and you know that doesn't work. But am I being compassionate? Am I censoring the voice and the choice of the person that I'm caring for? Am I just treating them like a human? You know, a human having a human experience. Mhm. Um I think that's and for me a good way to define respectful care. I have two more questions for you. So if we sat down five years from now, we're still around, we're still kicking, and all of us collectively together have successfully reduced racial disparities in birth outcomes. Woohoo. Right. What would have changed? We would have changed the human race. Nurses would remember that the joy and the passion that they have about being a clinician. They would think back to nursing school to college to their clinical experience where they were like, "Oh my god, I love this so much. What you going to pay me to do this?" they would tap into that joy that they had then and be able to intellectually say getting back to that joy means showing up as my best self for the patient and ensuring that the person that I'm privileged to care for has the best experience. So it's not just a good thing to do. I really feel like it's a retention tool and we saw that at our hospital. We also measured retention and turnover. And this was all during a crazy thing that we called a pandemic. And we had our highest retention when we were able to give our staff the tools that they need and to make it a priority and to hold them accountable and to celebrate them. All of the things when we're able to do that, our employees thrived and that was what led to the culture change. So I think that's it that we would connect our joy and our passion to the work and the work means our best selves for the betterment of the patient that we're able to cure. It's clearly connected and correlated. Again, rising tide lifts all boats. I'm happy. I'm joyful. I've had days and I'm sure you have as well, Sarah. I've had days in labor everywhere. It's like, oh my god, every bed is taken. It is crazy pants out here and the level of chaos. But if I intentionally say, you know what, man, it's going to be a great night. I'm just like feeling it's going to be a great night. And that's how I show up. Before I go into a patient's room, I take those deep breaths. I'm entering into sacred space and I'm like, pause at the door. Hi. Hi. How can you know that? I leave those shifts feeling exhausted. I remember many times my feet are killing me. It's exhausted. I remember one shift that I had shoe covers on. I think I went to the O early in the shift and was too busy to take them off. And you know when you've worn through your whole shoe cover that it's like halfway up your sneak. I remember specifically looking at somebody pointed it out on day like girl what happened to been through it. But I remember feeling so joyful because I had made the intention, you know, and our patients were great and everything worked out, right? Because I made that I made the commitment, the determination that, okay, this is how I'm going to show up and it's going to be great. So that's what would have changed. We would have changed. It reminds me about from move that actually we're turning into a live class. um all the content we did at MOOVE which is live colorfully the creative art of nursing centering the patient experience for better outcomes is very long title but one of the quotes from that class is everything around me changes when I change it's unknown I wish I could credit somebody but that is the basis of the entire class okay my last question for you to build off of that is what is one thing so these nurses are listening and one of my pet peeves whenever I go to a training or whenever I'm at a conference, I'm like, but tell me what to do. And so from your perspective, what is one thing one nurses can do that has a bigger impact than maybe they realize to be a part of the change towards shifting the future. I love that. My one thing would be enter every conversation with curiosity. Just curiosity. You know, and judgment is super easy for us. That's our default, right? Curiosity. Really? Wow. Tell me more about that. That's fascinating. Ask questions. Be curious. Don't don't think you know. Be open. That's my one thing. And I'll add to that that that is going to open your eyes to so much more color and so much more beauty and so much more appreciation for the individuals in front of you, for your job, for the work of birth, for birth itself. I literally can't think of a better piece of advice for nurses. I agree. Well, thank you for being here again. I I could come up with 600 more questions. So, who knows what'll happen next season or if there'll even be a next season. We're flexing and flowing. I'm kidding. There will probably be a next season. Um, but thank you again to your followers. I know. I know. They'll all have a heart attack. They're stressed about us not doing Move again. And I'm like, y'all just take a deep breath. We're not. But there's so many fun things in our future, including podcast. And right now, I have no no plans for this to be our last season. So, thank you for being a part of it. Thank you for being a part of this community and all the work that you're doing. And I think for me my biggest takeaway is like just rein it back and focus in on like literal little tangible goals. It's the starfish. It's you know it's it's not thinking quite so big all the time that like you have you have influence but you also have only so much influence. And so how do you make that influence really count? And that's in the case of nursing with our patients, but like in every every person encounter and to make your goals a lot more tangible. So, thank you for that for me and again for being a part of this about the of this podcast, but really it's about a part of this community. Thank you. Thank you. And thank you Sarah for all the work that you do and uh the ray of sunshine that you bring into your spaces because that's definitely amplifying all the color as well. So, thank you. I would like to cordially invite you to our live colorfully class. I know it keeps coming up. I talked about it last episode. It's going to keep coming up because again to me this class is what nursing needs right now and it is my love letter to you. It is bringing the science and validation and hope and also tangible tools to improve your lives to help you sustain your career to establish routines that actually help support patient outcomes and the patient experience for them to not walk away traumatized from their experience. And so I invite you to our live colorfully class. There's all sorts of things else going on over at Bundleberg Nurses. I'll drop everything in the show notes down below. Thank you for being here. Thank you for listening. Thanks for staying tuned after all of these many seasons. And thank you for spending your time with us during this episode of Happy Hour with Bundleird Nurses. If you like what you heard, it helps us all us both meaning it helps you come back to the episode. And it helps us continue to be able to do what we do if you subscribe, rate, leave a raving review, and then share this episode with a friend. If you want more from us, head to bundle nurses.com. Make sure you subscribe to our email list. I send out monthly education via email. I've done the last couple of ones have been on shared decision-m this upcoming month which will go out on July 1st if you're listening in real time is on informed refusal which is a piece of the live colorfully class that I will expand upon in the live colorfully class. I'll link that down below or you can of course follow us on socials. So now it's your turn to take what you learned today, apply it to your life, and go get curious, not judgmental, and snorkel your patience, snorkel your experiences. If you don't know what that means, join us in the Live Colorfully class, and I will explain that metaphor that's been so incredibly transformational for me. We'll see you next time.